HIGH RISK STRATEGY EFFICACY IN PROGNOSIS OF PRIMARY ONSET OF ISCHEMIC HEART

High morbidity and mortality from ischemic heart disease (CHD) in RF presupposes the significance of individual prognosis of cardiovascular risk and of primary prevention.Aim.To analyze the level of risk that could be calculated in patients with CHD debut just before the manifest of the disease and therefore to evaluate the opportunities for the CHD debut by standard scores; to evaluate the relation of a real volume of primary prevention events to current Guidelines.Material and methods.In 122 patients hospitalized with CHD debut as an acute coronary syndrome, a retrospective cardiovascular risk evaluation, which could be found just before the onset of the disease.Results.The prevalence of traditional risk factors among persons with CHD onset was high: 88% patients had ≥3 risk factors. However, before the onset of acute coronary syndrome 68% patients at Framingham scale and 47% by SCORE could have been under the low and moderate calculated risk that shows low sensitivity for the real CHD risk. Calculated risk by the scores has not correlated with the severity of coronary vessels lesion. In analysis of primary prevention events in was found that in the studied group drug therapy of dyslipidemia was not being performed as primary prevention, though it is indicated by the standards for at least 82% patients.Conclusion.The data shows that the use of the main risk scores underestimates real chance of CHD development in the exact patient. Also even for the patients, who require statin prescription for the aim of primary prevention, this therapy is not prescribed.

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Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome

Journal of Primary Care & Community Health ◽

10.1177/2150132720946949 ◽

2020 ◽

Vol 11 ◽

pp. 215013272094694

Author(s):

Andrés Gaviria-Mendoza ◽

Julián Andrés Zapata-Carmona ◽

Andrés Alirio Restrepo-Bastidas ◽

Carmen Luisa Betancur-Pulgarín ◽

Jorge Enrique Machado-Alba

Keyword(s):

Acute Coronary Syndrome ◽

Cardiovascular Risk ◽

Primary Prevention ◽

Risk Score ◽

High Intensity ◽

Real Life ◽

Risk Scores ◽

Coronary Syndrome ◽

Cardiovascular Risk Score ◽

Clinical Records

Background: Cardiovascular disease, especially coronary disease, represents one of the main causes of morbidity and mortality. Objective: To determine the drug prescription profile for primary cardiovascular prevention prior to a first acute coronary syndrome event. Methods: Cross-sectional study. We included adult patients of any sex affiliated with one healthcare insurer of the Colombian Health System, with a diagnosis of a first episode of acute coronary syndrome that occurred during the period of 2015 to 2016. Sociodemographic, clinical and pharmacological variables were evaluated from clinical records. The cardiovascular risk score prior to the event was calculated, and the need for the use of statins and aspirin in primary prevention was defined according to the recommendations of clinical practice guidelines. Results: Clinical records of 322 patients were reviewed with mean age of 61.9 ± 10.8 years, and 77.3% were men. The most frequent comorbidities were dyslipidemia (64.3%), arterial hypertension (62.7%) and diabetes mellitus (30.1%); 22% of the patients were obese, and 33.5% were smokers. The cardiovascular risk score was calculated in 211 patients (65.5%) who had the necessary variables complete. The median 10-year risk according to Framingham risk score was 21.4%, and it was 16.3% according to the American Heart Association. From the 211 patients with risk scores, there were 179 (84.8%) who needed statins (175 of high intensity, 97.8%), and 88 (27.3%) required aspirin as a primary prevention; however, 56 of these patients (31.3%) did not receive any statins, 127 (72.6%) did not receive the high intensity statin they needed, and 38 (43.2% of those with indication) lacked aspirin. Conclusion: Real-life data show that among a group of patients with high cardiovascular risk, a substantial proportion were not receiving medications for primary prevention necessary to reduce their risk and finally suffered an acute coronary event.

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